Suzuki Y, Hiraishi H, Kanke K, Watanabe H, Ueno N, Ishida M, Masuyama H, Terano A
Second Department of Internal Medicine, Dokkyo University School of Medicine, Tochigi, Japan.
Gastrointest Endosc. 1999 Feb;49(2):192-9. doi: 10.1016/s0016-5107(99)70485-2.
This study attempted to determine the indication for endoscopic mucosal resection with a ligating device (EMRL) and to assess the efficacy of radical (complete) resection of early gastric carcinoma and adenoma.
Sixteen patients with early gastric carcinoma (17 lesions) and 21 patients with gastric adenoma (23 lesions) underwent EMRL with an endoscope with a ligating device. After epinephrine solution was injected into the submucosa, the lesions were aspirated, ligated, and resected.
Twelve of 17 early carcinomas (70.6%) and 18 of 23 adenomas (78.3%) were radically resected by EMRL. The average size of the resected specimens was 12.8 x 11.0 mm. The rate of successful radical resection by EMRL, including piecemeal resection, was 100% (15/15) for lesions located in the antrum, 80% (4/5) in the angle, 61.1% (11/18) in the body, and 0% (0/2) for lesions at the cardia. Repeat EMRL was performed successfully in cases of partial resection (n = 3). No serious complication was encountered. No recurrence of the tumors was identified in cases of radical resection during a median follow-up period of 22.8 months.
EMRL is suitable for the treatment of gastric tumorous lesions. For the treatment of early carcinoma, well-differentiated mucosal carcinomas smaller than 10 mm located in the distal stomach represent the best indication for EMRL.
本研究旨在确定使用结扎装置的内镜黏膜切除术（EMRL）的适应证，并评估早期胃癌和腺瘤根治性（完全）切除的疗效。
16例早期胃癌患者（17个病灶）和21例胃腺瘤患者（23个病灶）接受了带结扎装置的内镜下EMRL治疗。在向黏膜下层注射肾上腺素溶液后，对病灶进行抽吸、结扎并切除。
17个早期癌灶中有12个（70.6%）、23个腺瘤中有18个（78.3%）通过EMRL实现了根治性切除。切除标本的平均大小为12.8×11.0毫米。对于位于胃窦的病灶，包括分片切除在内，EMRL的根治性切除成功率为100%（15/15），胃角为80%（4/5），胃体为61.1%（11/18），贲门处病灶为0%（0/2）。部分切除的病例（n = 3）成功进行了重复EMRL。未遇到严重并发症。在中位随访期22.8个月期间，根治性切除的病例未发现肿瘤复发。
EMRL适用于胃肿瘤性病变的治疗。对于早期癌的治疗，位于胃远端、分化良好、直径小于10毫米的黏膜癌是EMRL的最佳适应证。
